Reply: A comment on impaired peri-nidal cerebrovascular reserve in seizure patients with brain arteriovenous malformations

Abstract

Sir, We wish to thank the editor for offering us the opportunity to respond to this letter. We very much appreciate the detailed assessment of our work concerning the MRI assessment of vascular reserve in the vicinity of parenchymal brain arteriovenous malformations by Sturiale et al . Dr Sturiale’s primary issue with our study concerned the lack of comparison between our cerebrovascular reactivity findings and electrophysiological information that would have provided stronger support for our pathophysiological hypothesis relating seizures to reduced cerebrovascular reactivity. Our initial inclination was to make this correlation, but we quickly decided against it due to the well-known difficulties in localization of seizure foci in relation to the arteriovenous malformation nidus. Seizure foci are traditionally thought to be directly related to the arteriovenous malformations spatially, but there is good evidence that this is not always so. Support for a wider distribution of epileptogenic tissue including more distant sites secondary to ‘kindling’, was pointed out by Sturiale et al …